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Everything you say is so true. Every healthcare CIO I speak to cites "finding and retaining top IT talent" as their No. 1 challenge. Every project is a priority -- until, like ICD-10, it isn't. The change to value-based pay, meaningful use, and everything else plus typical business issues (like the ones you describe so well, such as bad debt) make this an extremely challenging environment. That's why I hope vendors, payers, providers, etc., can work together more seamlessly (with or without government oversight, although it sounds as though it's missed the boat in terms of no oversight) on really improving EHR interoperability so that's one less thing for strapped HIT departments to deal with.

The high cost of self-pay insurance was one major reason I returned to corporate work after 10 years as a successful freelance writer and editor, so I know exactly what you mean @Gary-El. Three years ago, I spent about $600 per month to insure me and my daughter; it was good insurance, but didn't include maternity or anything related to that (fortunately, my husband and I didn't want any more kids) and no dental.

That said, interoperability between EHRs is one of the primary selling points of electronic records. Without this, EHRs -- while still an improvement over paper records -- are simply digital versions of last decade's folders. As my story said, patients believe records are complete and transferable so mistakes will (and do) happen, resulting in injury/sickness/death. The fault for those negative results falls on someone other than the patient. IF there is wilful prevention (and that's a big "IF"), then it has to end. Now. If it's simply an overly complex problem, then it must be simplified. Fast.

There are a lot of dynamics at play here, and suffice it to say that our Healthcare system is severely screwed up. Hospitals rely in a huge extent on payments from insurance companies, and insurance companies have a living matrix in place to make it as hard as possible to pay for claims. Plus hospitals take a huge bath on charity care patients and bad debt in general. So the money left over for IT projects is always sketchy, and top talent is not exactly working at hospitals as a result.

Some of these issues do seem to be more political than having anything to do with vendors. It's always easy to take a potshot at EHR developers, but I agree with you and Mansur who was quick to point out that HIXs -- and states' differing acceptance/adoption and rate of successful rollout -- have a lot to do with providers' ability to read disparate systems/providers' records. I don't know which states might be worse at HIX than others or whether any are 'proactively blocking' integration efforts but this would have to be part of any investigation into EHRs.

I gather EHR interoperability has improved a lot but, compared with other industries, healthcare is severely lacking -- and that is what lawmakers in this committee appear to be frustrated and angered by, especially as taxpayer money has paid for so much of this investment. As one of those taxpayers, I'm glad it's getting scrutiny.

It's unsurprising to me: We've seen this before in other industries where vendors and/or participants were slow to work with competitors on sharing information. Once end-customers (patients) grew louder in their complaints and some customers (providers) got upset, steps were made but they weren't fast or deep enough, compared with other industries. When an industry doesn't take enough steps, fast enough, voluntarily, government usually steps in with a big stick. If you look back, pundits have warned of this eventuality for years. And here it is, apparently.

I hadn't thought of that before. Deliberately installed roadblocks could well be a significant reason for the slow progress of interoperability between the EHR systems. If someone who's loved one died because of this makes enough noise about it and prosecutors can make a good case of it, I'll cheer more loudly than anyone else as the perpetrator is hauled off to prison

Obamacare is saving me a fortune, because, as a freelancer, I can no longer be forced to pay ruinous rates for individualized policies, and if any of you are paying a bit more because you can't steal from me any more, well, isn't that just too bad?

I'm curious as to which states are using software that blocks the ONC API necessary to interact with the larger Obamacare HIX? I'd wager every single one of them has or is continuing to obstinantly not participate in the federal exchange, which, at this point, is utterly futile. As much of a steaming pile of fail Obamacare is, the fact is, it's not going anywhere antime soon. To continue blocking API interactivity is simply punishing average Joe Americans whose only "sin" is that their regular insurance was taken over by Obamacare.

I can honestly say that interoperability has improved quite a bit the last several years. Not at the speed it would in the non-healthcare world necessarily, but nothing ever moves at that speed within healthcare IT. That said, I remember just a couple of years ago being frustrated because so many of these systems operated as a "black box". Now, they all (for the most part) integrate pretty freely.

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